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Chinese herbal medicine for schizophrenia - Cochrane systematic review of randomised trials

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Chinese herbal medicine has been used to treat millions of people with schizophrenia for thousands of years. To evaluate Chinese herbal medicine as a treatment for schizophrenia. A systematic review of randomised controlled trials (RCTs). Seven trials were included. Most studies evaluated Chinese herbal medicine in combination with Western antipsychotic drugs; in these trials results tended to favour combination treatment compared with antipsychotic alone (Clinical Global Impression ;not improved/worse' n=123, RR=0.19, 95% CI 0.1-0.6, NNT=6,95% CI 5-11; n=109, Brief Psychiatric Rating Scale ;not improved/worse' RR=0.78,95% CI 0.5-1.2; n=109, Scale for the Assessment of Negative Symptoms ;not improved/worse' RR=0.87,95% CI 0.7-1.2; n=109, Scale for the Assessment of Positive Symptoms ;not improved/worse' RR=0.69,95% CI 0.5-1.0, NNT=6 95% CI 4-162). Medium-term study attrition was significantly less for people allocated the herbal/antipsychotic mix (n=897, four RCTs, RR=0.34,95% CI 0.2-0.7, NNT=23,95% CI18-43). Results suggest that combining Chinese herbal medicine with antipsychotics is beneficial.
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10.1192/bjp.bp.106.026880Access the most recent version at doi:
2007, 190:379-384.BJP
John Rathbone, Lan Zhang, Mingming Zhang, Jun Xia, Xiehe Liu, Yanchun Yang and Clive E. Adams
systematic review of randomised trials
Chinese herbal medicine for schizophrenia : Cochrane
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BackgroundBackground Chinese herbalmedicineChinese herbalmedicine
has been u sed t ot r eatmillions of peopl ehas been usedtotreat millions ofpeople
w ith sch i z ophrenia for thousands of years.withschizophrenia for thousands of years.
AimsAims To evaluate ChineseherbalTo evaluat e Chinese herba l
medi cine as a t reatmentfor sch izophren ia.medici ne as a treatmen tfor schizophrenia.
MethodMethod A syst emat i c rev iew ofA systematic review of
randomised controlled trials (RCTs).random i sed cont r olled trial s (R CTs).
ResultsResults Seventrialswere included.Seventrials were included.
Most studiesevaluated Chinese herbalMost studies evaluated Chinese herbal
medi cine in combination wi thW est ernmedi cine in combi nation w ithWestern
antipsychotic drugs; inthese trialsresultsantipsychotic drugs; inthese trialsresults
t e nded t o fa vour com b inationt r eat m e ntt e nded t o fa v ou rcombina tiont rea t m ent
compared with antipsychotic alonecompared with antipsychotic alone
(Clinical Global Impression‘notimproved/(Clinical Global Impression‘notimproved/
worseworsenn¼123, RR123, RR¼0.19,95% CI 0.1^0.6,0.1 9 ,95% CI 0.1^0.6,
NNTNNT¼ 6,95% CI 5^11;6,95% CI 5^11; nn¼109,Brief109 ,Brief
Psy ch iat r i c Rat i ng Scale‘ no t impr oved/Psychiatric Rating Scale ‘notimproved/
worseRRworseRR¼0.78,95% CI 0.5^1.2;0.78,95% CI 0.5^1.2; nn¼109 ,109 ,
Scale for the Assessmen t of Negat iveScale for the Assessmentof Negative
Symptomsnotimproved/worseSymptomsnotimproved/worse
RRRR¼0.87,95% CI 0.7^1.2;0.87,95% CI 0.7^1.2; nn¼109 , Scale for109 , Scale for
the Assessmentof Positive Symptomsnotthe Assessmentof Positive Symptomsnot
improved/worseRRimproved/worseRR ¼ 0.69,95% CI 0.5^0.69, 95% CI 0.5^
1.0, NNT1.0, NNT ¼6 95% CI 4^162).Medium-term695% CI 4^162).Medium-term
study at trition was significantly less forstud y attr it i on was s i g nificantl yless for
people al located the herbal /an ti psychoticpeople al located the herbal /ant ipsy choti c
mix (mix (nn ¼ 897, four RCTs,RR897, four RCTs,RR¼0.34,95% CI0.34,95% CI
0.2^0.7,NNT0.2^0.7,N NT¼2 3,95% CI 18^43).23,95% CI18^43).
ConclusionsConclusions Resul ts suggestthatResu lts suggestthat
combining Chinese herba lmed i c ine withcombin ing Chi nese herbal med ici ne wi th
antipsychoticsis beneficial.antipsychoticsis beneficial.
Declaration of interestDeclaration of interest None.None .
Chinese medicine, now commonly referredChinese medicine, now commonly referred
to as ‘traditional Chinese medicine’ hasto as ‘traditional Chinese medicine’ has
been used to treat schizophrenia-like illnessbeen used to treat schizophrenia-like illness
for over 2000 years (Ming, 2001).for over 2000 years (Ming, 2001).
Although antipsychotic drugs are the main-Although antipsychotic drugs are the main-
stay of treatment both in China and in thestay of treatment both in China and in the
West, they are associated with seriousWest, they are associated with serious
adverse effects such as tardive dyskinesiaadverse effects such as tardive dyskinesia
and tremor. In addition, about 20% of peo-and tremor. In addition, about 20% of peo-
ple do not respond adequately to treatmentple do not respond adequately to treatment
(Brenner(Brenner et alet al, 1990). Some earlier reports, 1990). Some earlier reports
have suggested that Chinese herbal medi-have suggested that Chinese herbal medi-
cine is effective for psychosis and that com-cine is effective for psychosis and that com-
bination treatments (drugs plus herbs) arebination treatments (drugs plus herbs) are
useful to enhance antipsychotic efficacy oruseful to enhance antipsychotic efficacy or
reduce the period of recovery and adversereduce the period of recovery and adverse
effects (Saku, 1991; Wang, 1998effects (Saku, 1991; Wang, 1998aa).).
The methodology used in traditionalThe methodology used in traditional
Chinese medicine to diagnose and treatChinese medicine to diagnose and treat
schizophrenia differs from that used inschizophrenia differs from that used in
Western medicine. Traditional ChineseWestern medicine. Traditional Chinese
medicine differentiates cases of schizo-medicine differentiates cases of schizo-
phrenia into syndromes, and it is thesephrenia into syndromes, and it is these
syndromes rather than the disease labelsyndromes rather than the disease label
such as schizophrenia orsuch as schizophrenia or dian kuangdian kuang (with-(with-
drawal mania), that determine treatmentdrawal mania), that determine treatment
(Fig. 1). There are five main syndromes that(Fig. 1). There are five main syndromes that
fall within the disease category offall within the disease category of diandian
kuangkuang which may also include the Westernwhich may also include the Western
diagnosis of schizophrenia. The five typesdiagnosis of schizophrenia. The five types
are:are:
(a)(a) phlegm-fire;phlegm-fire;
(b)(b) phlegm-damp;phlegm-damp;
(c)(c) qi stagnation with blood stasis;qi stagnation with blood stasis;
(d)(d) hyperactivity of fire due to yin defi-hyperactivity of fire due to yin defi-
ciency;ciency;
(e)(e) other miscellaneous types (Zhang,other miscellaneous types (Zhang,
1996).1996).
Each syndrome has a specific herbalEach syndrome has a specific herbal
formulation, but patients typically haveformulation, but patients typically have
mixed clinical presentations requiringmixed clinical presentations requiring
formulas to be adapted by adding or sub-formulas to be adapted by adding or sub-
tracting herbs. To complicate matters, intracting herbs. To complicate matters, in
China herbal medicines are sometimes usedChina herbal medicines are sometimes used
within the Western diagnostic paradigmwithin the Western diagnostic paradigm
alone without incorporating traditionalalone without incorporating traditional
theory. Nevertheless, because of the enor-theory. Nevertheless, because of the enor-
mous population of China, even if herbalmous population of China, even if herbal
medicines are given to only a small propor-medicines are given to only a small propor-
tion of the estimated 13 million Chinesetion of the estimated 13 million Chinese
people with schizophrenia, these treatmentpeople with schizophrenia, these treatment
approaches could still be some of the mostapproaches could still be some of the most
prevalent used for this illness.prevalent used for this illness.
METHODMETHOD
Full details of all methods used and the pre-Full details of all methods used and the pre-
defined inclusion criteria are published else-defined inclusion criteria are published else-
where (Rathbonewhere (Rathbone et alet al, 2005). Randomised, 2005). Randomised
controlled trials were included if partici-controlled trials were included if partici-
pants had schizophrenia, schizophreniformpants had schizophrenia, schizophreniform
psychosis or a schizophrenia-like illness,psychosis or a schizophrenia-like illness,
diagnosed by any criteria. Interventionsdiagnosed by any criteria. Interventions
included Chinese herbal medicines (plant,included Chinese herbal medicines (plant,
animal or mineral) given in any dosage oranimal or mineral) given in any dosage or
combination, with or without a basis in tra-combination, with or without a basis in tra-
ditional Chinese medical theory, comparedditional Chinese medical theory, compared
with any other approach.with any other approach.
Studies were identified from searches ofStudies were identified from searches of
the Cochrane Schizophrenia Group’s registerthe Cochrane Schizophrenia Group’s register
of trials, which incorporates regular searchesof trials, which incorporates regular searches
of BIOSIS Inside, CENTRAL, CINAHL,of BIOSIS Inside, CENTRAL, CINAHL,
EMBASE, MEMBASE, MEDLINEEDLINE and PsycINFO; theand PsycINFO; the
hand-searching of relevant journals andhand-searching of relevant journals and
conference proceedings and searches ofconference proceedings and searches of
several grey literature sources. Additionalseveral grey literature sources. Additional
databases searched included the Traditionaldatabases searched included the Traditional
Chinese Medical Literature Analysis andChinese Medical Literature Analysis and
Retrieval System, the Chinese BiomedicalRetrieval System, the Chinese Biomedical
Database, the China National KnowledgeDatabase, the China National Knowledge
Infrastructure database and the Allied andInfrastructure database and the Allied and
Complementary Medicine DatabaseComplementary Medicine Database
(AMED). Full details of the English and(AMED). Full details of the English and
Mandarin phrases used are reported else-Mandarin phrases used are reported else-
where (Rathbonewhere (Rathbone et alet al, 2005)., 2005).
Data were not utilised from studies inData were not utilised from studies in
which more than 50% of participants inwhich more than 50% of participants in
any group were lost to follow-up (this doesany group were lost to follow-up (this does
not include the outcome of ‘leaving thenot include the outcome of ‘leaving the
study early’). In studies with a less thanstudy early’). In studies with a less than
50% withdrawal rate people leaving the50% withdrawal rate people leaving the
study early were considered to have hadstudy early were considered to have had
the negative outcome, except for the eventthe negative outcome, except for the event
of adverse effects and death. For binaryof adverse effects and death. For binary
outcomes, the fixed-effects relative riskoutcomes, the fixed-effects relative risk
and its 95% confidence interval were calcu-and its 95% confidence interval were calcu-
lated. The numbers needed to treat/harmlated. The numbers needed to treat/harm
(NNT/NNH) were also calculated. An esti-(NNT/NNH) were also calculated. An esti-
mate of the weighted mean differencemate of the weighted mean difference
(WMD) between groups and its 95% confi-(WMD) between groups and its 95% confi-
dence interval were calculated for continu-dence interval were calculated for continu-
ous data. Data were not pooled ifous data. Data were not pooled if
standard deviations were too wide, suggest-standard deviations were too wide, suggest-
ing considerable skew (Altman & Bland,ing considerable skew (Altman & Bland,
1996). Heterogeneity between studies was1996). Heterogeneity between studies was
379379
BRITISH JOURNAL OF PSYCHIATRYBRITISH JOURNAL OF P SYCHIATRY (2007), 190, 379^384. doi: 10.1192/bjp.bp.106.026880(2007), 190, 379^384. doi: 10.1192/bjp.bp.106.026880 REVIEW ARTICLEREVIEW ARTICLE
Chinese herbal medicine for schizophreniaChinese herbal medicine for schizophrenia
C och rane sy st e ma t i c r evie w of random i sed t r i a lsC och rane sy st e ma t i c r evi ew of random i sed t r i a ls
J OHN RATHBONE, LAN ZHANG, MI NGMING ZHANG, JUN XIA,J OHN RATHBONE, LAN ZHANG, MINGMING ZHANG, JUN XIA,
XIEHE LIU, YANCHUN YANGXIEHE LIU, YANCHUN YANG andand CLIVE E. ADAMSCLI VE E. ADAMS
AUTHOR S PROOFAUTHOR S P ROOF
RATHBONE ET ALRATHBONE ET AL
assessed by inspecting the relevant graph;assessed by inspecting the relevant graph;
this was supplemented using thethis was supplemented using the II
22
statisticstatistic
(Higgins(Higgins et alet al, 2003). If inconsistency was, 2003). If inconsistency was
high (high (5575%), the data were not pooled75%), the data were not pooled
but were presented separately and thebut were presented separately and the
reasons for heterogeneity investigated.reasons for heterogeneity investigated.
Citations were inspected independentlyCitations were inspected independently
by at least two reviewers. The reliabilityby at least two reviewers. The reliability
of the data extraction was checked using aof the data extraction was checked using a
10% sample. Full reports of studies of10% sample. Full reports of studies of
agreed relevance were obtained, quality-agreed relevance were obtained, quality-
rated (Aldersonrated (Alderson et alet al, 2004) and data ex-, 2004) and data ex-
tracted for details of methods, participants,tracted for details of methods, participants,
interventions and outcomes. Disagreementsinterventions and outcomes. Disagreements
between reviewers were discussed and ifbetween reviewers were discussed and if
they could not be resolved further infor-they could not be resolved further infor-
mation was sought from authors. Mainmation was sought from authors. Main
outcomes of interest were predefined asoutcomes of interest were predefined as
clinical response in global or mental state,clinical response in global or mental state,
adverse events including extrapyramidaladverse events including extrapyramidal
adverse effects, service use including hospi-adverse effects, service use including hospi-
talisation and relapse, quality of life, leav-talisation and relapse, quality of life, leav-
ing the study early, death and economicing the study early, death and economic
evaluations.evaluations.
RESULTSRESULTS
Electronic searches resulted in over 640Electronic searches resulted in over 640
citations but most clearly did not meet thecitations but most clearly did not meet the
inclusion criteria. Full copies of only 14inclusion criteria. Full copies of only 14
studies were obtained, of which we couldstudies were obtained, of which we could
include 7 (Table 1). Of those we excluded,include 7 (Table 1). Of those we excluded,
three were not randomised (Cao & Wang,three were not randomised (Cao & Wang,
2000; Gong2000; Gong et alet al, 2000; Rong, 2001), three, 2000; Rong, 2001), three
did not report usable data (Zhaodid not report usable data (Zhao et alet al,,
1997; Wang, 19981997; Wang, 1998bb; Han; Han et alet al, 2002) and, 2002) and
one study did not use Chinese herbal medi-one study did not use Chinese herbal medi-
cine (Zhen & Feng, 1992).cine (Zhen & Feng, 1992).
We identified 16 citations dating fromWe identified 16 citations dating from
1987 to 2002 for the seven included stu-1987 to 2002 for the seven included stu-
dies. Overall, descriptions of studies weredies. Overall, descriptions of studies were
poorly reported. Two trials were availablepoorly reported. Two trials were available
in both Chinese and English (Luoin both Chinese and English (Luo et alet al,,
1997; Zhang1997; Zhang et alet al, 2001), four in Chinese, 2001), four in Chinese
only (Mengonly (Meng et alet al, 1996; Zhu, 1996; Zhu et alet al, 1996;, 1996;
ChenChen et alet al, 1997; Zhang, 1997; Zhang et alet al, 1997) and, 1997) and
one in English only (Zhangone in English only (Zhang et alet al, 1987)., 1987).
All seven included studies were conductedAll seven included studies were conducted
in China and were described as beingin China and were described as being
randomised, but none gave a descriptionrandomised, but none gave a description
of the allocation procedure. Double-blindof the allocation procedure. Double-blind
methodology was used in three studies, allmethodology was used in three studies, all
of which usedof which used Ginkgo bilobaGinkgo biloba extractextract
(EGb761) combined with antipsychotics.(EGb761) combined with antipsychotics.
All trials included in this review containedAll trials included in this review contained
a moderate risk of bias (category B; Alder-a moderate risk of bias (category B; Alder-
sonson et alet al, 2004). Trials ranged in sample, 2004). Trials ranged in sample
size from 40 to 545 participants and lastedsize from 40 to 545 participants and lasted
from 20 days to 6 months. Only one studyfrom 20 days to 6 months. Only one study
(Zhang(Zhang et alet al, 1997) attempted to allocate, 1997) attempted to allocate
treatment according to traditional Chinesetreatment according to traditional Chinese
medicine syndrome differentiation. Themedicine syndrome differentiation. The
other six studies employed Westernother six studies employed Western
diagnoses of schizophrenia with no furtherdiagnoses of schizophrenia with no further
differentiation into the traditional Chinesedifferentiation into the traditional Chinese
syndromes, and six used operational diag-syndromes, and six used operational diag-
nostic criteria. Three studies includednostic criteria. Three studies included
people with chronic schizophrenia (meanpeople with chronic schizophrenia (mean
duration 17 years), three did not reportduration 17 years), three did not report
participants’ history of illness and oneparticipants’ history of illness and one
study involved mostly people at firststudy involved mostly people at first
admission to hospital.admission to hospital.
H erbal medici ne al oneH erbal medici ne alone
v.v.
chlorpromazinechlorpromazine
Only one study (ZhangOnly one study (Zhang et alet al, 1987) gave, 1987) gave
the treatment group herbal medicinesthe treatment group herbal medicines
without the addition of an antipsychotic.without the addition of an antipsychotic.
Over a 20-day period, global state outcomeOver a 20-day period, global state outcome
‘not improved/worse’ significantly favoured‘not improved/worse’ significantly favoured
the control group receiving chlorpromazinethe control group receiving chlorpromazine
((nn¼90; RR90; RR¼1.88, 95% CI 1.2 to 2.9,1.88, 95% CI 1.2 to 2.9,
NNHNNH¼ 4, 95% CI 2 to 14). No participant4, 95% CI 2 to 14). No participant
left the study early.left the study early.
H erbal med i ci ne pl usH erbal medici ne plus
antipsychoti csantipsychotics
v.v.
antipsychoti csanti psychotics
al onealone
Herbal medicines given according to tra-Herbal medicines given according to tra-
ditional Chinese medicine syndrome differ-ditional Chinese medicine syndrome differ-
entiation in only one study (Zhangentiation in only one study (Zhang et alet al,,
1997), using1997), using dang gui cheng qi tangdang gui cheng qi tang oror xiaoxiao
yao sanyao san when combined with anti- when combined with anti-
psychotic medication (unspecified) scoredpsychotic medication (unspecified) scored
significantly lower for the outcome ofsignificantly lower for the outcome of
global state ‘not improved/worse’ than theglobal state ‘not improved/worse’ than the
control group given unspecified antipsycho-control group given unspecified antipsycho-
tics (NNTtics (NNT¼6, 95% CI 5 to 11; Fig. 2(a)).6, 95% CI 5 to 11; Fig. 2(a)).
Further global state data from the ClinicalFurther global state data from the Clinical
Global Impression (CGI) scale MengGlobal Impression (CGI) scale Meng etet
alal (1996), unknown antipsychotic; Zhu(1996), unknown antipsychotic; Zhu etet
alal (1996), chlorpromazine also favoured(1996), chlorpromazine also favoured
the herbal medicine plus antipsychoticthe herbal medicine plus antipsychotic
group (Fig. 2(b)).group (Fig. 2(b)).
ZhangZhang et alet al (2001) found Brief Psychi-(2001) found Brief Psychi-
atric Rating Scale (BPRS) scores dichoto-atric Rating Scale (BPRS) scores dichoto-
mised to ‘not improved/worse’ weremised to ‘not improved/worse’ were
equivocal (equivocal (nn¼109, RR109, RR¼ 0.78, 95% CI 0.50.78, 95% CI 0.5
to 1.2) whento 1.2) when Ginkgo bilobaGinkgo biloba plus haloperi-plus haloperi-
dol were compared with haloperidol, asdol were compared with haloperidol, as
were data from the Scale for the Assessmentwere data from the Scale for the Assessment
of Negative Symptoms (SANS) (of Negative Symptoms (SANS) (nn¼ 109,109,
RRRR¼0.87, 95% CI 0.7 to 1.2). However,0.87, 95% CI 0.7 to 1.2). However,
the Scale for the Assessment of Positivethe Scale for the Assessment of Positive
Symptoms (SAPS) did slightly favour theSymptoms (SAPS) did slightly favour the
herbal medicine plus haloperidol combina-herbal medicine plus haloperidol combina-
tion (tion (nn¼109, RR109, RR¼ 0.69, 95% CI 0.5 to0.69, 95% CI 0.5 to
1.0; NNT1.0; NNT¼ 6, 95% CI 4 to 162). Continu-6, 95% CI 4 to 162). Continu-
ous short-term BPRS data Mengous short-term BPRS data Meng et alet al
(1996), unknown antipsychotic; Zhu(1996), unknown antipsychotic; Zhu et alet al
(1996), chlorpromazine significantly(1996), chlorpromazine significantly
favoured the herbal medicine plus antipsy-favoured the herbal medicine plus antipsy-
chotic combination (Fig. 2(c)), but datachotic combination (Fig. 2(c)), but data
were heterogeneous (were heterogeneous (II
22
¼81%). Medium-81%). Medium-
term BPRS data (Fig. 2(c)) also favouredterm BPRS data (Fig. 2(c)) also favoured
the herbal medicine plus antipsychoticthe herbal medicine plus antipsychotic
combination: Luocombination: Luo et alet al (1997), antipsy-(1997), antipsy-
chotics clozapine, chlorpromazine, sul-chotics clozapine, chlorpromazine, sul-
piride, perphenazine and haloperidol; andpiride, perphenazine and haloperidol; and
ZhangZhang et alet al (2001), haloperidol ((2001), haloperidol (nn¼621,621,
WMDWMD¼ 774.17, 95% CI4.17, 95% CI 775.5 to5.5 to 772.8).2.8).
Medium-term SANS scores (Fig. 2(d))Medium-term SANS scores (Fig. 2(d))
380380
AUTHOR S P ROOFAUTHORS PROOF
Fig. 1Fig.1 Diagnosis and treatment plan for schizophren ia in Weste rn and traditi onal Chinese med icine.Diagnosis and treatment plan for schizophrenia in Western and traditional Chinese medicine.
CHINE S E ME DI CINE IN S CHIZOPHRENIACHINESEMEDICINEINSCHIZOPHRENIA
381381
AUTHOR S PROOFAUTHOR S P ROOF
Ta b l e 1Ta b l e 1 Characte rist ics of incl ud ed stud iesCharacte ristics of includ ed stud ies
Incl uded stud iesInclud ed studies MethodsMethods ParticipantsParticipa nts Interve nt ionsInte rvent ions OutcomesOutcomes
DateDate
ofof
st udystudy
FirstFirst
authorauthor
NumberNumber
of publi ca-of publi ca-
tionstions
Dou b l e-Doub le-
blindblind
SettingSetting DurationDurati on
(weeks)(weeks)
HistoryHistory nn AgeAge
(years)(years)
GenderGender Experimental g roupExperime ntal group Control groupControl group Leavi ngLeavin g
st udystudy
earlyearly
GlobalGlobal
statestate
MentalMental
statestate
AdverseAdverse
effectseffects
19871987 ZhangZhang 22NKNK HH2.92.9 FEFE 9090 16^5116^51 NKNK DGCQ T 50 ml b.i.d. (DGC Q T 50 ml b.i.d. (nn¼45)45) Chlorpromazine, as required (Chlorpromazine, as requi red (nn¼45)45) YesYes YesYes NoNo NoNo
19961996 MengMeng 11YesYes HH88NKNK 4040 18^ 6018^60 M, FM, F Ginkgo bilobaGinkgo biloba
11
240mg/day+antipsychotics240mg/day+antipsychotics
((nn¼21)21)
Placebo + anti psychoticsPlacebo + anti psychotics
22
((nn¼19)19) Y esYes YesYes YesYes NoNo
19961996 ZhuZhu 11OLOL HH4.34.3 NKNK 6767 17^5317^53 FF HirudoHirudo && Rheum palmatumRheum palmatum
22
+ chlorpromazine,+ chlorpromazine,
300 mg/da y (300 mg/day (nn¼32)32)
Chlo rpromazine, 400 mg/dayChlorp romazine, 400 mg/day
((nn¼35)35)
YesYes YesYes YesYes YesYes
19971997 ChenChen 22SBSB HH26.126.1 CICI 120120 27^5827^58 NKNK XingshenXingshen + antipsychotics+ antipsychotics
33
, 300^700mg/day, 300^700 mg/day
((nn¼60)60)
Anti psychoticsAntipsychoti cs
33
,250^800mg/day,250^800mg/day
((nn¼60)60)
YesYes NoNo YesYes NoNo
19971997 LuoLuo 33YesYes HH1616 NKNK 545545 18^6018^60 M, FM, F Ginkgo bilobaGinkgo biloba
11
, 120 mg t.d.s. + antipsychotics, 120 mg t.d.s. + ant i psychotics
((nn¼315)315)
Placebo + anti psychoticsPlacebo + anti psychotics
44
((nn¼230)230) YesYes NoNo YesYes NoNo
19971997 ZhangZhang 11OLOL H, CH, C 1212 CICI 123123 Mean 32Mean 32 M, FM, F DGCQT or XYS, 200^300 ml/day +DGCQTor XYS, 200^300ml/day +
anti psychoticsantipsy chotics
22
((nn¼66)66)
Anti psychoticsAntipsychoti cs
22
((nn¼57)57) YesYes NoNo YesYes YesYes
20020011ZhangZhang 66YesYes HH1212 CICI 109109 27^6127^61 M , FM, F Ginkgo bilobaGinkgo biloba
11
, 360 mg + haloperidol, 360 mg + haloperidol
0.25 mg/kg per day (0.25 mg/kg per day (nn¼56)56)
Haloperidol, 0.25 mg/kg per dayHa loperidol, 0.2 5mg/kg pe r day
+placebo(+ placebo (nn¼53)53)
YesYes NoNo YesYes YesYes
C, community; CI, chronic illness; DGCQ T ,C, community; CI, chronic illness; DGCQ T , dang gui cheng qi tangdang gui cheng qi tang; F, female; H, hospital; M, male; NK, not known; OL, open label; SB, single-blind; XYS,;F,female;H,hospital;M,male;NK,notknown;OL,openlabel;SB,single-blind;XYS,x i ao yao sanxi ao yao san..
1. Standardised ext ract of1. Standardised extract of Ginkgo bil obaGinkgo biloba (EGb761).(EGb761).
2. No further details on medicine and/or dosage.2. No further details on medicine and/or dosage.
3. Chlorpromazine, clozapine, sulpiride.3 . Chlorpromazine, clozapine, sulpi ride.
4. Clozapine, chlorpromazine, sulpi ride, perphenazine and haloperidol.4. Clozapine, chlorpromazine, sulpiride, perphenazine and haloperidol.
RATHBONE ET ALRATHBONE ET AL
382382
Fig. 2Fig. 2 Comparison of herbal medicine + antipsychoticComparison of herbal medicine + antipsychotic vv.antipsychotic(BPRS,BriefPsychiatricRatingScale;NNT,numberneededtotreat;RR,relativerisk;SANS,. antipsychotic (BPRS, Brief Psychiatric Rating Scale; NNT, number needed to treat; RR, relative risk; SANS,
Scale for the Assessment of Negative Symptoms; WMD, weighted mean difference).Scale for the Assessment of Negative Symptoms; WMD, weighted mean difference).
CHINE S E ME DI CINE IN S CHIZOPHRENIACHINESEMEDICINEINSCHIZOPHRENIA
significantly favoured the herbal medicinesignificantly favoured the herbal medicine
plus antipsychotic group.plus antipsychotic group.
Adverse events are associated with anti-Adverse events are associated with anti-
psychotic medication, and combining her-psychotic medication, and combining her-
bal medicines with chlorpromazine (Zhubal medicines with chlorpromazine (Zhu
et alet al, 1996) did not mitigate extrapyrami-, 1996) did not mitigate extrapyrami-
dal adverse effects, with both groups beingdal adverse effects, with both groups being
equivocal. Constipation, however, wasequivocal. Constipation, however, was
significantly lower in the herbal plussignificantly lower in the herbal plus
antipsychotic combination group (0/32)antipsychotic combination group (0/32)
despite patients receiving the constipatingdespite patients receiving the constipating
antipsychotic chlorpromazine (antipsychotic chlorpromazine (nn ¼ 67;67;
RRRR¼0.03, 95% CI 0.0 to 0.5; NNH0.03, 95% CI 0.0 to 0.5; NNH¼ 2,2,
95% CI 2 to 4); the comparison group95% CI 2 to 4); the comparison group
(chlorpromazine alone) fared less well (19/(chlorpromazine alone) fared less well (19/
35). Medium-term studies found signifi-35). Medium-term studies found signifi-
cantly fewer patients leaving the study earlycantly fewer patients leaving the study early
(Fig. 2(e)) in the herbal plus antipsychotic(Fig. 2(e)) in the herbal plus antipsychotic
group (group (nn¼897, four RCTs, RR897, four RCTs, RR¼ 0.34,0.34,
95% CI 0.2 to 0.7; NNT95% CI 0.2 to 0.7; NNT¼ 23, 95% CI 1823, 95% CI 18
to 43).to 43).
Sensitivity analysis:Sensitivity analysis:
Ginkgo bilobaGinkgo biloba
alone or plus antipsychoticsalone or plus antipsychotics
v.v.
antipsychoticsanti psychotics
Studies ofStudies of Ginkgo bilobaGinkgo biloba were tested in awere tested in a
sensitivity analysis by comparing them withsensitivity analysis by comparing them with
the original pooled data (the original pooled data (Ginkgo bilobaGinkgo biloba
data pooled with other herbs). Effect sizesdata pooled with other herbs). Effect sizes
for CGI and BPRS scores were increasedfor CGI and BPRS scores were increased
forfor Ginkgo bilobaGinkgo biloba when analysed sepa-when analysed sepa-
rately, although these differences were notrately, although these differences were not
statistically significant.statistically significant.
DIS CUSS IONDIS CUSSION
Six of the seven studies evaluated the use ofSix of the seven studies evaluated the use of
Chinese herbs for schizophrenia rather thanChinese herbs for schizophrenia rather than
traditional Chinese herbal medicine fortraditional Chinese herbal medicine for
schizophrenia, i.e. treatment was allocatedschizophrenia, i.e. treatment was allocated
according to a diagnosis of schizophreniaaccording to a diagnosis of schizophrenia
without further differentiation accordingwithout further differentiation according
to traditional Chinese methodology. Studyto traditional Chinese methodology. Study
sizes were generally small and pooled datasizes were generally small and pooled data
were typically derived from one or twowere typically derived from one or two
studies. All outcomes, therefore, werestudies. All outcomes, therefore, were
underpowered. The one study that incorpo-underpowered. The one study that incorpo-
rated traditional Chinese medical theoryrated traditional Chinese medical theory
did show significant improvement in globaldid show significant improvement in global
state but was limited by lack of blinding.state but was limited by lack of blinding.
There were no descriptions of allocationThere were no descriptions of allocation
concealment and no assurances that blind-concealment and no assurances that blind-
ing was maintained. The type of anti-ing was maintained. The type of anti-
psychotic used and the dosages were oftenpsychotic used and the dosages were often
poorly reported, although three studiespoorly reported, although three studies
used the same herbal intervention used the same herbal intervention GinkgoGinkgo
bilobabiloba (EGb761). The remainder, however,(EGb761). The remainder, however,
used different herbal medicines, andused different herbal medicines, and
unfortunately all threeunfortunately all three Ginkgo bilobaGinkgo biloba studiesstudies
used different antipsychotic medications.used different antipsychotic medications.
H erbal medi ci ne aloneH erbal medi ci ne alone
v.v.
antipsychoticsantipsychoti cs
Global state measured as ‘not improved/Global state measured as ‘not improved/
worse’ favoured the chlorpromazine groupworse’ favoured the chlorpromazine group
(NNT with chlorpromazine 4, 95% CI 2(NNT with chlorpromazine 4, 95% CI 2
to 14) when compared with the treatmentto 14) when compared with the treatment
group receivinggroup receiving dang gui cheng qi tangdang gui cheng qi tang..
This NNT concurs with findings whenThis NNT concurs with findings when
chlorpromazine is compared with placebochlorpromazine is compared with placebo
(Adams(Adams et alet al, 2007); however, this is based, 2007); however, this is based
on a single study (on a single study (nn¼90; Zhang90; Zhang et alet al, 1987), 1987)
lasting 20 days with participants given Chi-lasting 20 days with participants given Chi-
nese herbs according to a diagnosis ofnese herbs according to a diagnosis of
schizophrenia without using traditionalschizophrenia without using traditional
Chinese medicine differentiation. ResultsChinese medicine differentiation. Results
must therefore be interpreted with cautionmust therefore be interpreted with caution
given the design limitations, but neverthe-given the design limitations, but neverthe-
less do not supportless do not support dang gui cheng qi tangdang gui cheng qi tang
as a sole treatment for schizophrenia.as a sole treatment for schizophrenia.
Herbal medi ci ne plusHerbal medi ci ne plus
antipsychoticsantipsychoti cs v.v. anti psychoticsantipsychotics
The herbal medicine group receiving eitherThe herbal medicine group receiving either
dang gui cheng qi tangdang gui cheng qi tang oror xiao yao sanxiao yao san plusplus
antipsychotics were significantly less likelyantipsychotics were significantly less likely
to have an outcome of ‘no change or worse’to have an outcome of ‘no change or worse’
compared with participants receiving onlycompared with participants receiving only
antipsychotics, measured using the Clinicalantipsychotics, measured using the Clinical
Global Impression scale (NNTGlobal Impression scale (NNT¼6, 95% CI6, 95% CI
5 to 11). This could be an important finding5 to 11). This could be an important finding
and does fit with the CGI continuousand does fit with the CGI continuous
scores. These results are broadly encoura-scores. These results are broadly encoura-
ging and suggest that combining herbalging and suggest that combining herbal
medicines with antipsychotics might bemedicines with antipsychotics might be
beneficial, although results are only basedbeneficial, although results are only based
on two small studies (totalon two small studies (total nn¼103). These103). These
vaguely positive finding also apply to men-vaguely positive finding also apply to men-
tal state outcomes. The dichotomised BPRStal state outcomes. The dichotomised BPRS
and SANS measures reported by Zhangand SANS measures reported by Zhang etet
alal (2001);(2001); nn¼109) were equivocal, but109) were equivocal, but
SAPS scores again showed borderline sig-SAPS scores again showed borderline sig-
nificance in favour of the herbal medicinenificance in favour of the herbal medicine
plus antipsychotic combination. Medium-plus antipsychotic combination. Medium-
term continuous SANS data, however, pro-term continuous SANS data, however, pro-
vided more robust results, with threevided more robust results, with three
studies (studies (nn¼741) favouring the herbal plus741) favouring the herbal plus
antipsychotic combination group. The ex-antipsychotic combination group. The ex-
perimental group had, on average, nineperimental group had, on average, nine
points less on this scale than those allocatedpoints less on this scale than those allocated
to antipsychotic drugs alone. In our opi-to antipsychotic drugs alone. In our opi-
nion, in this group of chronically unwellnion, in this group of chronically unwell
people such an average difference wouldpeople such an average difference would
be noticeable and clinically meaningful.be noticeable and clinically meaningful.
Further supporting this improvement, bothFurther supporting this improvement, both
short-term and medium-term BPRS scoresshort-term and medium-term BPRS scores
were significantly better for those receivingwere significantly better for those receiving
herbal medicines plus antipsychotics com-herbal medicines plus antipsychotics com-
pared with those receiving antipsychoticpared with those receiving antipsychotic
drugs alone, although there was heteroge-drugs alone, although there was heteroge-
neity in these results. The latter might haveneity in these results. The latter might have
been due to the use of different anti-been due to the use of different anti-
psychotic drugs between trials.psychotic drugs between trials.
Adverse effect Treatment EmergentAdverse effect Treatment Emergent
Signs and Symptoms scores were reportedSigns and Symptoms scores were reported
by Zhangby Zhang et alet al (2001), but standard devia-(2001), but standard devia-
tions were wide and no conclusion can betions were wide and no conclusion can be
made with confidence. Only one studymade with confidence. Only one study
(Zhu(Zhu et alet al , 1996;, 1996; nn¼67) reported extra-67) reported extra-
pyramidal symptoms, and these were notpyramidal symptoms, and these were not
significantly different between groups. Insignificantly different between groups. In
one trial in which both groups were givenone trial in which both groups were given
chlorpromazine, constipation was signifi-chlorpromazine, constipation was signifi-
cantly more frequent in the control groupcantly more frequent in the control group
(NNH(NNH¼ 2). In this trial the herb used was2). In this trial the herb used was
a purgative used also in Western medicinea purgative used also in Western medicine
Rhizoma rhei palmatumRhizoma rhei palmatum (rhubarb).(rhubarb).
Numbers of participants leaving theNumbers of participants leaving the
study early in the short term were similarstudy early in the short term were similar
for both groups. Medium-term datafor both groups. Medium-term data
showed significantly fewer left early in theshowed significantly fewer left early in the
herbal medicine plus antipsychotic groupherbal medicine plus antipsychotic group
compared with people receiving only anti-compared with people receiving only anti-
psychotics (psychotics (nn¼897; 2%897; 2% v.v. 7%). In the con-7%). In the con-
text of these studies, the addition of herbaltext of these studies, the addition of herbal
medicine did not worsen treatment compli-medicine did not worsen treatment compli-
ance and there is the suggestion that theance and there is the suggestion that the
addition of the herbal medicine made itaddition of the herbal medicine made it
easier for participants to take standardeasier for participants to take standard
antipsychotics.antipsychotics.
We did aWe did a post hocpost hoc sensitivity analysissensitivity analysis
for the single herbfor the single herb Ginkgo bilobaGinkgo biloba, used, used
outside the traditional Chinese medicineoutside the traditional Chinese medicine
approach within a Western model ofapproach within a Western model of
schizophrenia. We found no evidence thatschizophrenia. We found no evidence that
this particular herb had remarkable effects.this particular herb had remarkable effects.
The application of traditional ChineseThe application of traditional Chinese
herbal medicine is fundamentally inter-herbal medicine is fundamentally inter-
woven with syndrome differentiation.woven with syndrome differentiation.
Failure to apply syndrome differentiationFailure to apply syndrome differentiation
may result in treatments being ineffectivemay result in treatments being ineffective
or even harmful. Despite this, there is someor even harmful. Despite this, there is some
evidence that these Chinese herbal medi-evidence that these Chinese herbal medi-
cines, combined with antipsychotics andcines, combined with antipsychotics and
given in a way that is not in keeping withgiven in a way that is not in keeping with
their normal use within traditional Chinesetheir normal use within traditional Chinese
medicine, may be beneficial for people withmedicine, may be beneficial for people with
schizophrenia across a range of outcomes.schizophrenia across a range of outcomes.
If these medicines are used within theirIf these medicines are used within their
usual context the positive effects could beusual context the positive effects could be
greater. Even the gains seen in this reviewgreater. Even the gains seen in this review
would still be important for the millionswould still be important for the millions
for whom these treatments are used. Bothfor whom these treatments are used. Both
West and East need well-reported (MoherWest and East need well-reported (Moher
et alet al, 2001) randomised trials that are, 2001) randomised trials that are
adequately powered, blinded and of suffi-adequately powered, blinded and of suffi-
cient duration so we can detect meaningfulcient duration so we can detect meaningful
383383
AUTHOR S PROOFAUTHOR S P ROOF
RATHBONE ET ALRATHBONE ET AL
treatment effects with high levels of confi-treatment effects with high levels of confi-
dence.dence.
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384384
AUTHOR S PROOFAUTHOR S P ROOF
JOHN RATHBONE, MPhil,Cochrane Schizophrenia Group, Academic Department of PsychiatryJOHN RATHBONE, MPhil ,Coch rane Schizophrenia Group, Academic Depart m e nt of Ps ychi a try
and Behavioural Sciences,University of Leeds UK; LAN ZHANG,MD, Institute of Mental Health, MINGMINGand Behavioural Sciences,University of Leeds UK; LAN ZHANG,MD, Institute of Mental Health,MINGMING
ZHANG, MSc,Chinese Cochrane Centre,West China Hospital of Sichuan University,Chengdu,China;JUNXIA,ZHANG,MSc,Chinese Cochrane Centre,West China Hospital of Sichuan University,Chengdu,China; JUN XIA,
BSc,Cochrane Schizophrenia Group, Academic Department of Psychiatry and Behavioural Sciences,UniversityBSc,Cochrane Sch i zophr en i a G r oup , Academic Departme n t of Psy ch ia t ry and Behavioural Scienc es,Univ ers ity
of Leeds,UK; XIEHE LIU, MD,YANCHUN YANG,MD, Institute of Mental Health,West China Hospital ofof Leeds,UK; XIEHE LIU, MD,YANCHUN YANG, MD, Institute of Mental Health,West China Hospital of
Sichuan University, Chengdu, China; CLIVE ELLIOTTADAMS, MD,Cochrane Schizophrenia Group, AcademicSichuan University,Chengdu,China; CLIVE ELLIOTTADAMS,MD,Cochrane Schizophrenia Group, Academic
Department of Psychiatry and Behavioural Sciences,University of Leeds,UKDepartment of Psychiatry and Behavioural Sciences,University of Leeds,UK
Correspondence :John Rathbone,Cochrane Schizophrenia Group, Academic Department of PsychiatryCorrespondence:John Rathbone,Cochrane Schizophrenia Group, Academic Department of Psychiatry
and Behavioural Sciences,University of Leed s,15 HydeTerrace,Leeds LS2 9LT,UK.Tel: +44 (0)113 343and Behavioural Sciences,University of Leeds,15 HydeTerra ce, Leeds LS2 9LT,UK.Tel: +44 (0)113 343
1897; fax: +44 (0)113 3432723; em ail: jrathbone1897; fax: +44 (0)113 3432723; email: jrathbone@@cochrane-sz.orgcochrane-sz.org
(First received 31May 2006, final revision 8 September 2006, accepted 16 January 2007)(First received 31May 2006, final revision 8 September 2006, accepted 16 January 2007)
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... Research on Traditional Chinese medicine suggests that Chinese herbal medicine may work well in combination with antipsychotic drugs (Rathbone et al., 2007). Patients receiving electroacupuncture along with electroconvulsive therapies were shown to have fewer schizophrenic symptoms than controls. ...
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Schizophrenia is a severe mental illness that has devastating consequences for those who suffer from the disorder. The epidemiology of schizophrenia indicates that it occurs relatively often, in many different contexts, and in conjunction with other disorders, decreasing quality of life and causing premature death. There has been an enormous amount of research into the causes of schizophrenia and there is now have a much better understanding of the genetic, environmental, and psychological factors that contribute to the disease. While there are numerous ways to understand and conceptualize schizophrenia, a unified picture of the neurobiology, changes in brain structure, cognitive and social-cognitive impairments related to the disorder has yet to emerge. Convulsive therapies and psychosurgery were used unsuccessfully, indiscriminately and without scientific validation in the past to treat schizophrenia. Medical advances including advanced imaging technology have now provided the ability to perform specifically focused neuromodulation and psychosurgery in severe and treatment resistant cases of schizophrenia. While still at a preliminary stage, these approaches have the potential to yield effective treatments in the future. For the last 70 years antipsychotic medication has become the prevailing treatment for schizophrenia. However, many people suffering from the disorder have trouble with side-effects and adhering to a regimen of antipsychotic medication. Newer pharmacological agents are being developed and include not only novel antipsychotic drugs, but anti-inflammatory and immunomodulating agents as well. These new agents, used either alone or in combination, have the potential to improve outcomes for people suffering from schizophrenia. Nevertheless, conclusively better pharmacotherapies will likely not arise until there is better understanding of the pathophysiology underlying schizophrenia. After the development of antipsychotic medication, psychotherapeutic methods for treating schizophrenia fell out of favor, but there is currently some reversal of this trend. The use of newer psychotherapies and modified forms of older therapeutic treatments are not only targeting the symptoms of schizophrenia but are also now focusing on recovery from the disorder. These newer approaches as well as efforts at preventing schizophrenia show promise in reducing the suffering caused by this disease.
... Further research is needed to expand the spectrum of CNS disorders modeled in zebrafish and treated with TCMs. For example, as multiple TCM herbs have been used to treat schizophrenia (Rathbone et al., 2007), zebrafish offers several experimental models highly relevant to this disorder , enabling to screen potential pro-and antipsychotic TCMs in this aquatic model. Overall, with continuous development of modern biology, pharmacy and analytical technology, the adaptability of zebrafish model in TCM research will also improve (Stewart et al., 2015). ...
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Ethnopharmacological relevance: Although Traditional Chinese Medicine (TCM) has a millennia-long history of treating human brain disorders, its complex multi-target mechanisms of action remain poorly understood. Animal models are widely used to probe the effects of various TCMs on brain and behavior. The zebrafish (Danio rerio) has recently emerged as a novel vertebrate model for neuroscience research, and is increasingly used for CNS drug screening and development. Aim of the study: As zebrafish models are only beginning to be applied to studying TCM, we aim to provide a systematic review about the TCM effects using zebrafish models. Materials and methods: A comprehensive search of published literature was conducted using biomedical databases (Web of Science, Pubmed, Sciencedirect, Google Scholar and China National Knowledge Internet, CNKI), with key search words zebrafish, brain, Traditional Chinese Medicine, herbs, CNS, behavior. Results: We recognize the growing use of zebrafish for studying TCM, as well as outline the existing model limitations, problems and challenges, as well as future directions of research in this field. Conclusions: We demonstrate the growing value of zebrafish models for studying TCM, aiming to improve our understanding of TCM' therapeutic mechanisms and potential in treating brain disorders.
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... For refractory schizophrenia patients, TCM attempts to treat them based on the individual's symptoms and signs, and such individualized treatment can maximize the effectiveness of Chinese medicine. Several analyses supporting the use of Chinese herbal medicine as a treatment for schizophrenia have been published, and concluding that adding Chinese herbal medicine to antipsychotic therapies may improve some outcomes in schizophrenia [13][14][15] . These investigations have been extended to patients with treatment refractory schizophrenia and several recent clinical trials involving the role of TCM as an adjunctive therapy have been published 16 , however, a meta-analysis of TCM in patients with refractory schizophrenia has yet to be conducted. ...
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Although recent studies focused on traditional Chinese medicine (TCM) for the treatment of refractory schizophrenia have reported that it may be beneficial, there is still lack of convincing evidence and critical meta-analytic work regarding its effectiveness as an adjunctive therapy. Therefore, we performed a meta-analysis to investigate the effectiveness of TCM in combination with antipsychotics for refractory schizophrenia. Fourteen articles involving 1725 patients published as of December 2016 were included which compared antipsychotic therapies to either TCM alone, or TCM as an adjunctive therapy. TCM was observed to have beneficial effects on aspects of the Positive and Negative Syndrome Scale (PANSS) including total score changes and negative score changes, as well as clinical effects estimated with PANSS or the Brief Psychiatric Rating Scale (BPRS). The changes in extrapyramidal side effects (RSESE) scores from baseline to the end of the treatment period were similar in two groups of related trials. TCM was also reported to mitigate some anti-psychotic related side-effects and overall, TCM adjuvant therapy was generally safe and well tolerated. While, the results indicated the potential utility of TCM as an alternative adjunctive therapeutic for refractory schizophrenia treatment, there remains a need for further high-quality studies.
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As we have noted before, many statistical methods of analysis assume that the data have a normal distribution.1 When the data do not they can often be transformed to make them more normal.2 Readers of published papers may wish to be reassured that the authors have carried out an appropriate analysis. When authors present data in the form of a histogram or scatter diagram then readers can see at a glance whether the distributional assumption is met. If, however, only summary statistics are presented—as is often the case—this is much more difficult. If the summary statistics …
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The current clinical psychiatric practice of herbal medicine in the People's Republic of China was explored by reviewing the literature. The results found in many of the articles were lacking methodological strictness. Some reliable articles reported that certain herbal medicines were effective for psychiatric conditions, and that a combination treatment of modern drugs with herbs was useful for the enhancement of the efficacy and the reduction of both recovery time and side effects. It is suggested that more sophisticated investigations are necessary to corroborate any conclusions concerning the value for herbal medicine in the psychiatric field.
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A clinical study of 67 female schizophrenics was conducted. Thirty two patients of them treated with the Shuizhi (leech)-Dahuang (rhubarb) mixture mainly with low dosage of antipsychotic drugs (combined therapy group), while other 35 cases were treated with antipsychotic drugs only (control group). The result showed that their overall therapeutic effects were similar and the combined therapy group could reduce the dosages of antipsychotic drugs and its side effects, and tended to normalize the hemorheologic indices.
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To assess the therapeutic effect of Shuxuening (SXN), the extractum of Ginkgo biloba761 (EGb761) in treating chronic schizophrenia. A double-blind, placebo-controlled multi-center research on the treatment of chronic schizophrenics with SXN was used. Five hundred and forty-five patients were randomly divided into either SXN group or the control group. Patients in the former group received SXN 120 mg three times daily. Patients in both groups received their maintenance neuroleptics throughout the 16-week research treatment. The patients' rating scores of brief psychiatric rating scale (BPRS) and Scale for the Assessment of Negative Symptoms reduced much greater in SXN group than those in the control group from the sixth week of treatment (P < 0.01). The effect of SXN for BPRS factors of retardation and thought disturbance was better than that of the control. SXN presented a better therapeutic effect for chronic schizophrenics than the control when rated with traditional global rating method as well, in which 44.98% marked improvement was obtained in SXN group compared to 20.98% in the control group. SXN combining neuroleptics, was an effective medicine for chronic schizophrenics. Moreover, it appeared few side-effects within the recommended dose range.
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In this study, 80 schizophrenic patients, divided into two groups of 40, were treated with traditional Chinese medicine to invigorate the blood and relieve stasis and antipsychotic drugs, and were observed by the rating methods of BPRS,TESS, CGI scale and hemorheology test. The results show that such traditional Chinese medicine to invigorate blood and relieve stasis has fewer side effects on schizophrenic patients than do antipsychotic drugs, and there is objective evidence of hemorheology changes. Traditional Chinese medicine is superior to antipsychotic drugs in the effects of anti-anxiety-depression and antipsychomotor inhibition, but it is less effective in controlling psychomotor excitation compared with antipsychotic drugs.